Adingwupu Ogechi M, Barbosa Ernesto Rodolpho, Palevsky Paul M, Vassalotti Joseph A, Levey Andrew S, Inker Lesley A
Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, MA.
Tufts University School of Medicine, Boston, MA.
Kidney Med. 2023 Sep 19;5(12):100727. doi: 10.1016/j.xkme.2023.100727. eCollection 2023 Dec.
RATIONALE & OBJECTIVE: Creatinine-based GFR estimating (eGFRcr) equations may be inaccurate in populations with acute or chronic illness. The accuracy of GFR equations that use cystatin C (eGFRcys) or creatinine-cystatin C (eGFRcr-cys) is not well studied in these populations.
A systematic review of original articles identified from PubMed and expert sources. Two reviewers screened articles independently and identified those meeting inclusion criteria.
SETTING & STUDY POPULATIONS: Adults and children with acute or chronic illness.
Studies published since 2011 that compared performance of eGFRcr, eGFRcys, and eGFRcr-cys relative to measured GFR (mGFR), used standardized assays for creatinine or cystatin C, and used eGFR equations developed using such assays. Studies of ambulatory clinical populations or research studies in populations with only CKD, kidney transplant recipients, only diabetes, kidney donor candidates, and community-based cohorts were excluded.
Data extracted from full text.
Bias and percentages of estimates within 30% of mGFR (P) of eGFR compared with mGFR were evaluated.
Of the 179 citations, 26 studies met the inclusion criteria: 24 in adults and 2 in children in clinical populations with cancer (n=5), HIV (n=5), cirrhosis (n=3), liver transplant (n=3), heart failure (n=2), neuromuscular diseases (n=1) critical illness (n=5), and obesity (n=2). In general, eGFRcr-cys had greater accuracy than eGFRcr or eGFRcys equations among study populations with cancer, HIV, and obesity, but did not perform consistently better in cirrhosis, liver transplant, heart failure, neuromuscular disease, and critical illness.
Participants were selected because of concern for inaccurate eGFRcr, which may bias results. Most studies had small sample sizes, limiting generalizability.
eGFRcr-cys improves GFR estimation in populations with a variety of acute and chronic illnesses, providing indications for cystatin C measurement. Performance was poor in many studies, suggesting the need for more frequent mGFR.
PLAIN-LANGUAGE SUMMARY: Kidney function, specifically glomerular filtration rate (GFR), estimated using creatinine (eGFRcr) is often inaccurate in people with acute and chronic illness. The accuracy of estimates using cystatin C alone (eGFRcys) or together with creatinine (eGFRcr-cys) is not well studied in these populations. We conducted a systematic review to address the knowledge gap. Of the 179 papers reviewed, we identified 26 studies in clinical populations with cancer (n=5); HIV (n=5); cirrhosis (n=3); liver transplant (n=3); heart failure (n=2); neuromuscular disease (n=1); critical illness (n=5); and obesity (n=2). In general, eGFRcr-cys improved the GFR estimation in HIV, cancer, and obesity, providing indications for cystatin C measurement. Performance was poor in many studies, suggesting the need for more frequent measured GFR.
基于肌酐的肾小球滤过率（GFR）估算（eGFRcr）方程在急性或慢性疾病人群中可能不准确。在这些人群中，使用胱抑素C的GFR方程（eGFRcys）或肌酐 - 胱抑素C的GFR方程（eGFRcr - cys）的准确性尚未得到充分研究。
对从PubMed和专家来源中识别出的原始文章进行系统综述。两名评审员独立筛选文章并确定符合纳入标准的文章。
患有急性或慢性疾病的成人和儿童。
2011年以来发表的研究，比较了eGFRcr、eGFRcys和eGFRcr - cys相对于实测GFR（mGFR）的性能，使用了肌酐或胱抑素C的标准化检测方法，并使用了基于此类检测方法开发的eGFR方程。排除了门诊临床人群的研究或仅针对慢性肾脏病（CKD）患者、肾移植受者、仅患有糖尿病的患者、肾脏供体候选者以及社区队列人群的研究。
从全文中提取数据。
评估与mGFR相比，eGFR在mGFR的30%范围内的偏差和估算百分比（P）。
在179篇引用文献中，26项研究符合纳入标准：24项针对成人，2项针对患有癌症（n = 5）、HIV（n = 5）、肝硬化（n = 3）、肝移植（n = 3）、心力衰竭（n = 2）、神经肌肉疾病（n = 1）、危重症（n = 5）和肥胖症（n = 2）的临床人群中的儿童。总体而言，在患有癌症、HIV和肥胖症的研究人群中，eGFRcr - cys比eGFRcr或eGFRcys方程具有更高的准确性，但在肝硬化、肝移植、心力衰竭、神经肌肉疾病和危重症中其表现并非始终更好。
由于担心eGFRcr不准确而选择参与者，这可能会使结果产生偏差。大多数研究样本量较小，限制了普遍性。
eGFRcr - cys改善了多种急性和慢性疾病人群的GFR估算，为胱抑素C检测提供了依据。许多研究中的表现不佳，表明需要更频繁地检测mGFR。
使用肌酐估算的肾功能，特别是肾小球滤过率（GFR）（eGFRcr）在急性和慢性疾病患者中往往不准确。在这些人群中，单独使用胱抑素C（eGFRcys）或与肌酐一起使用（eGFRcr - cys）估算的准确性尚未得到充分研究。我们进行了一项系统综述以填补这一知识空白。在审查的179篇论文中，我们在患有癌症（n = 5）、HIV（n = 5）、肝硬化（n = 3）、肝移植（n = 3）、心力衰竭（n = 2）、神经肌肉疾病（n = 1）、危重症（n = 5）和肥胖症（n = 2）的临床人群中确定了26项研究。总体而言，eGFRcr - cys改善了HIV、癌症和肥胖症患者的GFR估算，为胱抑素C检测提供了依据。许多研究中的表现不佳，表明需要更频繁地检测实测GFR。
